Provider Demographics
NPI:1104920222
Name:MOKA, GANAPATHI RAO (MD)
Entity type:Individual
Prefix:DR
First Name:GANAPATHI
Middle Name:RAO
Last Name:MOKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 MILL ST
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-2236
Mailing Address - Country:US
Mailing Address - Phone:724-375-1066
Mailing Address - Fax:724-375-8004
Practice Address - Street 1:2450 MILL ST
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-2236
Practice Address - Country:US
Practice Address - Phone:724-375-1066
Practice Address - Fax:724-375-8004
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021972E207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009525430001Medicaid
C30603Medicare UPIN